Montgomery: P4Q Practice Coordinator, LPN

HealthSpring of Alabama, Inc. is dedicated to improving the health of the community we serve by delivering the highest quality and greatest value in health care benefits and services.

We are seeking a P4Q Practice Coordinator, LPN for our Health Services Department in our Montgomery office.

Primary Function:
Coordinate and ensure that all communication is maximized effectively related to key processes and coordination between the practice, health plan, and any disease management vendor(s) associated with the Pay for Quality Program.

Responsibilities:
Participate and coordinate in all medical record audits and assist with communication between the RN auditors, practice staff and physicians.
Facilitate resolution of any discrepancies found during an audit between the medical record findings and disease management program placement.
Implement and maintain process for ongoing patient chronic disease identification. Communicate to the Health Plan clinical information for review and disease management placement.
Maintain process to gather information within the medical record and identify missing standards of care for an office visit/point of care event.
Ensure any pertinent point of care information is communicated appropriately. After an office visit, send clinical information to the Health Plan and/or vendor for member communication/calls.
Maintain and update treatment alerts and flow sheets for the member within the medical record (paper or EMR)
Develop and maintain process that encourages all HealthSpring members to receive a minimum of one office visit per year.
Coordinate with the practice lead physician to create and implement standing orders.
Identify and implement process to identify members that are in need of preventive screening tests and issue correspondence to prompt members to receive test.
Provide feedback to practice physicians regarding process improvement and opportunities for improvement.
Identify and communicate social services needs with the Health Plan for action.
Participate and assist with HEDIS medical record audit data collection process as instructed by the Health Plan.
Maintain current list of HealthSpring members to identify new patients and incorporate into existing P4Q activities.
Collaborate with local Practice Coordinators regarding process improvement, communication efforts, barriers/challenges, and understanding of overall program processes.
Participate in all operational meetings/calls as identified between the practice physicians and the Health Plan.
Communicate with the Health Plan appropriately and provide positive and constructive feedback on an ongoing basis.
Collaborate internally with physicians and staff to properly code disease categories.
Assist the Health Plan with data collection efforts related to proper coding, documentation, and data collection.
Utilize the Health Plan data to identify members applicable to the coding process.
Assist within the practice to reinforce training conducted by the Health Plan regarding the coding process and data collection efforts.

Job Related Skills:
Communicates information accurately and timely to internal and external staff. Written and oral communication is accurate and timely and at the appropriate level.
Ability to articulate information to personnel at all levels of understanding.
Ability to handle multiple tasks, set priorities, and develops action items.
Detail oriented.
Works independently, receiving a minimum of detailed supervision and guidance.
Word, Excel and Access experience preferred.

Position Requirement
License Vocational Nurse (LVN) or Licensed Practical Nurse (LPN)
Unrestricted licensure in the applicable state.

Key Objectives
Creates and manages all HealthSpring medical records and flow and alert sheets for all members
during the audit process or a minimum of 1-2 weeks prior to launch/live date.
MOE: All medical records contain a flow and alert sheet.

Submits all alert forms and/or communicate appropriate information regarding point of care (POC) encounter to the Health Plan and/or vendor.
MOE: Health Plan and/or vendor receive alert/treatment forms after POC.

Maintains process for ongoing identification of P4Q disease specific members and communicates appropriate clinical information for disease management program placement.
MOE: Health Plan received communication regarding new members or existing members with newly identified disease process with appropriate clinical information. Estimated communication based on volume of new membership and disease processes identified during an audit.

Actively and productively participates in all market level Practice Coordinator and Health Plan conference calls.
MOE: Participates in weekly call with minimal absences.

Maintains detailed understanding of all P4Q measures to ensure proper documentation within the medical record and communication with physicians when standards are not met.
MOE: Participates and verbalizes understanding during the baseline and subsequent audits appropriate level of understanding and provides evidence of communication with physicians as identified. May verbalize during coordination calls or during the audit process.

Conducts medical record audit as identified by the Health Plan and primarily responsible for any non-annual audit (interim / ongoing) data collection and data entry. (Health Plan conducts annual audit)
MOE: Effectively manages audit process to collect clinical measures / indicators and complete data entry in a database for reporting. IRR scores and over-read reveal minimal issues or lack of measure / indicator understanding.

MOE method of evaluation

Physical Demands:
The physical demands described below are representative of those that must be met by the employee to perform the essential functions of the job. If requested, reasonable accommodation may be made to enable individuals with disabilities to perform essential job functions.
While performing the duties of this job the employee is regularly required to sit, stand, walk, talk, hear and see. The employee must use both hands to feel and operate a computer keyboard. The vision requirements include: close vision, distance, vision, peripheral vision, depth perception and ability to focus.

HealthSpring offers a competitive salary and full range of benefits. Please remember to include Resume and salary requirements. No phone calls accepted.

Please apply via the URL: https://home.eease.com/recruit/?id=50699

HealthSpring of Alabama, Inc. is an EEO/AA employer.